It’s tough to keep up with the “latest and greatest” interventions for Post-Traumatic Stress Disorder (PTSD). It seems like there’s constantly a new “breakthrough” that never fully delivers. As a scientist-practitioner, I don’t pay much attention until I see a strong research base. So until recently, I’ve all but ignored claims that psychedelic drugs (MDMA, psilocybin, etc.) could bolster recovery from PTSD. However, it’s tough to ignore the successes reported in a recent Phase 3 trial. (Mitchell et al, 2021; Servick, 2021).
Another reason for my skepticism: I grew up in the '80s, fully immersed in the war against drugs. I know from Saturday morning commercials that drugs would scramble my brain like eggs in a frying pan. Nancy Regan instructed me and Arnold Jackson to “just say no.” And a police officer from D.A.R.E. (Drug Abuse Resistance Education) visited my elementary school classroom and warned us that one dose of LSD would give you flashbacks for life. Call me a prude, but I feared psychedelics until….well, today.
Phase 3 clinical trials are often the final step before a medication receives FDA approval. In the recently published Phase 3 study on MDMA for PTSD (Mitchell et al, 2021), 91 participants were randomized to receive a manualized psychotherapy combined with either MDMA or a placebo medication. At the end of the treatment, 67% of the participants who received MDMA no longer met criteria for PTSD, compared to 32% of those who received the placebo. The authors posit that MDMA facilitates trauma recovery by reducing anxiety, increasing self-compassion and social connection, and promoting fear extinction learning. Taken together, “MDMA, when combined with therapy, may produce a ‘window of tolerance’ ” that enables participants to engage in trauma processing with less distress and experience new learning while feeling safe.
This summary inspired me to learn more. After reading the Multidisciplinary Association for Psychedelic Studies’ (MAPS) protocol (MAPS, 2020) for MDMA-assisted therapy for PTSD and discussing it with respected colleagues, I aimed to look at this treatment innovation from a balanced perspective. You know, how I encourage my clients to approach new experiences. Here are my reactions as a self-identified skeptic:
After taking a deep dive into the research, I am more open to and curious about psychedelic-assisted psychotherapies for PTSD. The Phase 3 study provides initial data regarding the safety and effectiveness of this treatment, though not enough to replace the evidence-based psychotherapies that have decades’ worth of data to support them and that can be delivered safely within many clinical settings. In addition, the treatment as described in the recent study is not easily accessible to most patients. Nonetheless, it appears to be a valuable addition to our existing toolbox, particularly for patients with severe PTSD who have not responded to frontline treatments. So while I’ll continue to practice treatments like CPT and PE, I’m eager to see what findings emerge as this research continues and keep my fingers crossed that we’ll soon have another good option for our patients.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Carin Lefkowitz, Psy.D., is a clinical psychologist and Senior Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
Multidisciplinary Association for Psychedelic Studies (2020, May 22). A randomized, double-blind, placebo-controlled, multi-site phase 3 study of the efficacy and safety of manualized MDMA-Assisted psychotherapy for the treatment of severe posttraumatic stress disorder. Retrieved from https://maps.org/research/mdma/ptsd/phase3
Mitchell, J., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., Ot’alora, M., Garas, W., Paleos, C., Gorman, I., Nicholas, C., Mithoefer, M., Carlin, S., Poulter, B., Mithoefer, A., Quevedo, S., Wells, G., Klaire, S., van der Kolk, B., … & Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine. https://doi.org/10.1038/s41591-021-01336-3
Servick, K. (2021). A psychedelic win raises questions for PTSD therapy. Science, 372(6544), 774-775.